Rademaker K J, Lam J N G P, Van Haastert I C, Uiterwaal C S P M, Lieftink A F, Groenendaal F, Grobbee D E, de Vries L S
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
Semin Perinatol. 2004 Aug;28(4):279-87. doi: 10.1053/j.semperi.2004.08.005.
The objective of this study is to determine the relation between the size of the corpus callosum (CC) and motor performance in a population-based cohort of preterm children. Preterm born children (n = 221) with a gestational age less than or equal to 32 weeks and/or a birth weight below 1500 g were eligible for this study. At the age of 7 or 8 years, frontal, middle, posterior, and total areas (mm2) of the corpus callosum were measured on true midsagittal MRI. Due to anxiety of 10 children and motion artifacts in 7 other children, 204 MRIs could be assessed in the preterm group (mean GA 29.4 weeks, sd 2.0,mean BW 1200 g, sd 323). The preterm group consisted of 15 children with cerebral palsy (CP) and 189 children without CP. Motor function was established by using the Movement Assessment Battery for Children, and the Developmental Test of Visual Motor Integration was obtained. The same examinations were performed in 21 term born children. The mean total cross-sectional CC area was significantly smaller in preterm born infants compared with their term born controls (338 mm2 versus 422 mm2, P < 0.0001). The preterm children with CP had significantly smaller mean CC areas compared with the preterms who did not develop CP (P < 0.0001-P < 0.002). However, the preterms born without CP also had significantly smaller body, posterior, and total CC areas compared with term born controls (P < 0.0001-P < 0.002). Only the difference in frontal area measurements dilrc) -3.3 mm2/score point (95% CI -4.5, -2.1). The association existed in all parts of the CC but increased in the direction of the posterior part: frontal: lrc -0.8 mm2/score point (-1.2, -0.4), middle: lrc -1.1 mm2/score point (-1.7, -0.5) and posterior: lrc -1.4 mm2/score point (-1.8, -0.9). An association between CC area and its subareas and the standard scores of the VMI was also found. A larger CC was strongly related t o better scores onthe VMI test total area CC: lrc 0.05 score/mm2 (95% CI 0.03, 0.07), frontal: lrc 0.12 score/mm2 (0.05,0.19), middle: lrc 0.10 score/mm2 (0.05, 0.15) and posterior: lrc 0.12 score/mm2 (0.06, 0.18). After adjustment for gestational age, birth weight, and total cerebral area, these associations were still significant. There is a strong association between the size of the corpus callosum (total midsagittal cross area as well as frontal, middle, and posterior area) and motor function in preterm children, investigated at school age. A poorer score on the Movement ABC was related to a smaller CC. A larger CC was strongly associated with better VMI standard scores.
本研究的目的是确定在一个基于人群的早产儿队列中胼胝体(CC)大小与运动表现之间的关系。孕周小于或等于32周和/或出生体重低于1500克的早产儿(n = 221)符合本研究的条件。在7或8岁时,通过真正的正中矢状面MRI测量胼胝体的额叶、中间、后部和总面积(mm²)。由于10名儿童焦虑和另外7名儿童存在运动伪影,早产儿组中可评估204例MRI(平均孕周29.4周,标准差2.0,平均出生体重1200克,标准差323)。早产儿组包括15名脑瘫(CP)儿童和189名无CP儿童。使用儿童运动评估量表确定运动功能,并获得视觉运动整合发育测试结果。对21名足月儿进行了相同的检查。与足月儿对照组相比,早产儿的平均胼胝体总横截面积明显更小(338 mm²对422 mm²,P < 0.0001)。与未患CP的早产儿相比,患CP的早产儿平均胼胝体面积明显更小(P < 0.0001 - P < 0.002)。然而,未患CP的早产儿与足月儿对照组相比,其胼胝体的体部、后部和总面积也明显更小(P < 0.0001 - P < 0.002)。仅额叶面积测量的差异为-3.3 mm²/得分点(95%置信区间-4.5,-2.1)。胼胝体各部分均存在这种关联,但在后部方向上增加:额叶:-0.8 mm²/得分点(-1.2,-0.4),中间:-1.1 mm²/得分点(-1.7,-0.5),后部:-1.4 mm²/得分点(-1.8,-0.9)。还发现胼胝体面积及其子区域与视觉运动整合发育测试(VMI)的标准分数之间存在关联。更大的胼胝体与VMI测试更好的分数密切相关:胼胝体总面积:0.05分/mm²(95%置信区间0.03,0.07),额叶:0.12分/mm²(0.05,0.19),中间:0.10分/mm²(0.05,0.15),后部:0.12分/mm²(0.06,0.18)。在对孕周、出生体重和全脑面积进行调整后,这些关联仍然显著。在学龄期调查发现,早产儿的胼胝体大小(正中矢状面总横截面积以及额叶、中间和后部面积)与运动功能之间存在密切关联。儿童运动评估量表得分较差与胼胝体较小有关。更大的胼胝体与更好的VMI标准分数密切相关。